This should be best completed by a family member or carer who knows the patient well.

1. About You and the Patient

Please answer based on changes that have occurred since the patient first began to experience memory problems.

Only answer Yes if the symptom has been present during the last month.

If you answer Yes, then ONLY you answer a and b:

• how severe the symptom is for the patient
• how distressing it is for you as caregiver/informant

It will take 5-6 min to complete.

DOMAIN 1 — Delusions

If Yes, answer questions below (a and b) or skip to the next domain question

DOMAIN 2 — Hallucinations

If Yes, answer questions below (a and b) or skip to the next domain question

DOMAIN 3 — Agitation/Aggression

If Yes, answer questions below (a and b) or skip to the next domain question

DOMAIN 4 — Depression/Dysphoria

If Yes, answer questions below (a and b) or skip to the next domain question

DOMAIN 5 — Anxiety

If Yes, answer questions below (a and b) or skip to the next domain question